President Obama Tweaks Birth Control Policy

(USA TODAY) -- President Obama announced a plan today that attempts to accommodate certain religious employers opposed to a rule that would require them to provide access to birth control for women free of charge.

Obama announced that the rule would be tweaked so that in cases where non-profit religious organizations have objections, insurance companies would be required to reach out to employees and offer the coverage directly.

"Under the rule, women will still have access to free preventive care that includes contraceptive service no matter where they work," Obama said. "That core principle remains.

"But if a woman's employer is a charity or a hospital that has a religious objection to providing contraceptive services as part of their health plan, the insurance company -- not the hospital, not the charity -- will be required to reach out and offer the woman contraceptive care free of charge without co-pays, without hassle."

With that distinction, those organizations won't have to provide the coverage, pay for it or refer their employees to it. The requirement will rest with insurers.

Obama and Health and Human Services Secretary Kathleen Sebelius said they always had planned on working with religious institutions to get the mandate right. But they moved up their timetable after hearing vehement objections from the Catholic church and others.

"We weren't going to spend a year doing this," Obama said in brief remarks to reporters.

The change, loosely based on a regulation in effect in Hawaii, still leaves some unanswered questions. How will women be referred to insurers if they don't think of it themselves? Will the cost of contraceptives get added to premiums? And will other employers -- say, a strict Catholic who owns a restaurant -- be allowed the same exemption as hospitals, schools and charities?

Officials said that while the final rule goes into effect today, it will not be enforced on religious organizations that object until August 2013, leaving additional time to work out details.

The administration announced last month that religious-affiliated employers had to cover birth control as preventive care for women. Churches and houses of worship were exempt, but all other religiously affiliated organizations were ordered to comply.

The White House received backlash to the measure from Catholic clergy as well as Republican leaders this week. Obama cited "many genuine concerns" expressed by conscientious objectors.

"My first job in Chicago was working with Catholic parishes in poor neighborhoods, and my salary was funded by a grant from an arm of the Catholic Church," Obama said. "And I saw that local churches often did more good for a community than a government program ever could, so I know how important the work that faith-based organizations do and how much impact they can have in their communities.

I also know that some religious institutions -- particularly those affiliated with the Catholic Church -- have a religious objection to directly providing insurance that covers contraceptive services for their employees."

On the other hand, he cited "the more cynical desire on the part of some to make this into a political football."

"I understand some folks in Washington may want to treat this as another political wedge issue, but it shouldn't be," he said. "I certainly never saw it that way."

White House officials took pains to avoid the word "compromise," noting that under the accommodation, no woman who wants access to contraceptives should be denied.

Experts on religion said the accommodation isn't enough. "It's a shell game," says Robert Destro, law professor at Catholic University.

Frank Pavone, National Director of Priests for Life, said he remained unsatisfied.

"A resolution to this issue cannot only cover 'religious' employers," Pavone said. "Religious freedom, which includes freedom of conscience, does not belong only to religious entities but to every American. There are many non-religious reasons to object to the administration's policy."

Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, a registered nurse and a canon lawyer, noted that the administration has not changed it's definition of who is exempt. Instead, Obama just established a special provision for "non-exempt religious groups."

It's still a narrow definition focused on churches that employ and serve people of their faith, not schools, hospitals, social services or other ministries that are recognized under the tax code as exempt religious organizations. Until that's changed, Hilliard said, the government is still "cherry-picking to see which groups will be seen by our government as worthy of exemptions and which won't. "

Many Catholic institutions are self-insured and not covered under the mandate unless they update or alter their plans. No one knows how many health policies are held by Catholic agenicies, because every diocese and Catholic institution makes its own decisions in hundreds of thousands of separate corporations.

Within minutes of announcing the change in policy, the White House began rolling out endorsements from some Catholic organizations, including the Catholic Health Association and Catholics United. Planned Parenthood also applauded the action.

In a memo to reporters Friday morning, the Republican National Committee said Obama is trying to "ride the fence" on the issue.

"It's a dangerous game when dealing with a fundamental American right protected by the Constitution such as religious freedom," the RNC said in the memo.

House Speaker John Boehner this week called the mandate "an unambiguous attack on religious freedom" in a rare House floor speech and vowed legislative action to reverse it.

"If the president does not reverse the attack on religious freedom, then the Congress, acting on behalf of the American people and the Constitution we are sworn to uphold and defend, must," Boehner said. "This attack by the federal government on religious freedom in our country must not stand and will not stand."

Republican leaders have been joined by a few Democrats -- such as Sens. Robert Casey of Pennsylvania and Joe Manchin of West Virginia and House Democratic Caucus Chairman John Larson of Connecticut -- in calling for changes in the policy. Vice President Biden vowed in Ohio Thursday that a solution would be forthcoming.

The White House has pointed to 28 states with similar laws, including eight without the religious exemption contained in the federal rule, as proof that requiring free access to contraceptives is workable.

The rule goes into effect Aug. 1, but if objections are raised, another year's extension is possible.

That's been no consolation to Catholic leaders. The White House is "all talk, no action" on moving toward compromise, said Anthony Picarello, general counsel for the U.S. Conference of Catholic Bishops.

"There has been a lot of talk in the last couple days about compromise, but it sounds to us like a way to turn down the heat, to placate people without doing anything in particular," Picarello said this week. "We're not going to do anything until this is fixed."

That means removing the provision from the health care law altogether, he said, not simply changing it for Catholic employers and their insurers. He cited the problem that would create for "good Catholic business people who can't in good conscience cooperate with this."

"If I quit this job and opened a Taco Bell, I'd be covered by the mandate," Picarello said.

Senate Democrats who met with Obama on Wednesday came away convinced he would not back down on requiring some form of access for all women, regardless of where they work.

"We support the right of women in this country to have access to birth control through their insurance policies, and anybody who stands in the way is going to have to deal with us and our friends," said Sen. Barbara Boxer, D-Calif., flanked by four colleagues. Boxer said she had spoken to Obama adviser David Axelrod, who assured her that the administration would not weaken its position.

More than 600 physicians and medical students from 49 states signed a letter to Obama and Sebelius on Wednesday, urging them to stand firm in defense of the rule. They said millions of women rely on birth control pills for other medical conditions.

Roman Catholic leaders showed no sign of backing down, either.

"There's no room for compromise on this. The mandate has to go," said John Allen, senior correspondent for the National Catholic Reporter and author of numerous books on the Catholic church. "There's not much room for a conversation here."

The White House provided this fact sheet on women's preventive services and religious institutions:

Thanks to the Affordable Care Act, most health insurance plans will cover women's preventive services, including contraception, without charging a co-pay or deductible beginning in August, 2012. This new law will save money for millions of Americans and ensure Americans nationwide get the high-quality care they need to stay healthy.

Today, President Obama will announce that his Administration will implement a policy that accommodates religious liberty while protecting the health of women. Today, nearly 99 percent of all women have used contraception at some point in their lives, but more than half of all women between the ages of 18-34 struggle to afford it.

Under the new policy to be announced today, women will have free preventive care that includes contraceptive services no matter where she works. The policy also ensures that if a woman works for religious employers with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide contraception coverage, but her insurance company will be required to offer contraceptive care free of charge.

The new policy ensures women can get contraception without paying a co-pay and addresses important concerns raised by religious groups by ensuring that objecting religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception. Background on this policy is included below:

• Section 2713 of the Affordable Care Act, the Administration adopted new guidelines that will require most private health plans to cover preventive services for women without charging a co-pay starting on August 1, 2012. These preventive services include well women visits, domestic violence screening, and contraception, and all were recommended to the Secretary of Health and Human Services by the independent Institute of Medicine of the National Academy of Science.

• Today, the Obama Administration will publish final rules in the Federal Register that:

o Exempts churches, other houses of worship, and similar organizations from covering contraception on the basis of their religious objections.

o Establishes a one year transition period for religious organizations while this policy is being implemented.

• The President will also announce that his Administration will propose and finalize a new regulation during this transition year to address the religious objections of the non-exempted religious organizations. The new regulation will require insurance companies to cover contraception if the non-exempted religious organization chooses not to. Under the policy:

o Religious organizations will not have to provide contraceptive coverage or refer their employees to organizations that provide contraception.

o Religious organizations will not be required to subsidize the cost of contraception.

o Contraception coverage will be offered to women by their employers' insurance companies directly, with no role for religious employers who oppose contraception.

o Insurance companies will be required to provide contraception coverage to these women free of charge.

Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services. For example, there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii. One study found that covering contraception lowered premiums by 10 percent or more.